EP3777660B1 - Werkzeug zur färbung einer gemischten elektroanatomischen karte mit ziehbarer geodätischer überlagerung - Google Patents

Werkzeug zur färbung einer gemischten elektroanatomischen karte mit ziehbarer geodätischer überlagerung

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Publication number
EP3777660B1
EP3777660B1 EP20190531.2A EP20190531A EP3777660B1 EP 3777660 B1 EP3777660 B1 EP 3777660B1 EP 20190531 A EP20190531 A EP 20190531A EP 3777660 B1 EP3777660 B1 EP 3777660B1
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European Patent Office
Prior art keywords
map
region
base map
geodesic
maps
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EP20190531.2A
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English (en)
French (fr)
Other versions
EP3777660A1 (de
EP3777660C0 (de
Inventor
Assaf COHEN
Itai Doron
Amiram Sheiner
Illya Shtirberg
Assaf Govari
Christopher Thomas Beeckler
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Biosense Webster Israel Ltd
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Biosense Webster Israel Ltd
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Publication of EP3777660C0 publication Critical patent/EP3777660C0/de
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Classifications

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    • A61B5/0036—Features or image-related aspects of imaging apparatus, e.g. for MRI, optical tomography or impedance tomography apparatus; Arrangements of imaging apparatus in a room including treatment, e.g., using an implantable medical device, ablating, ventilating
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    • G06F—ELECTRIC DIGITAL DATA PROCESSING
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    • G06F3/01—Input arrangements or combined input and output arrangements for interaction between user and computer
    • G06F3/048—Interaction techniques based on graphical user interfaces [GUI]
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    • G06F3/04845—Interaction techniques based on graphical user interfaces [GUI] for the control of specific functions or operations, e.g. selecting or manipulating an object, an image or a displayed text element, setting a parameter value or selecting a range for image manipulation, e.g. dragging, rotation, expansion or change of colour
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Definitions

  • the present invention relates generally to cardiac mapping, and particularly to visualizing anatomical cardiac maps.
  • U.S. Patent Application Publication 2007/0003119 describes display and navigation methods for multiple computer-aided detection (CAD) detections.
  • a medical image is displayed to a viewer, and a request is received to instantiate CAD-assisted viewing.
  • a timewise presentation sequence for the CAD detections is automatically computed according to a predetermined sequencing criterion.
  • For each CAD detection an expanded presentation 2-dimensional window floating on a computer screen is displayed for its associated location in the medical image, the expanded presentation windows being displayed according to the timewise presentation sequence.
  • U.S. Patent Application Publication 2010/0268059 describes an exemplary method that includes accessing cardiac information acquired via a catheter located at various positions in a venous network of a heart of a patient.
  • the cardiac information comprises position information, electrical information and mechanical information.
  • Local electrical activation times are mapped to anatomic positions to generate an electrical activation time map.
  • Local mechanical activation times are mapped to anatomic positions to generate a mechanical activation time map.
  • An electromechanical delay map is generated by subtracting local electrical activation times from corresponding local mechanical activation times, and at least the electromechanical delay map is rendered to a display.
  • U.S. Patent Application Publication 2003/0016850 describes systems and graphical user interfaces for analyzing body images.
  • the invention provides a graphical user interface having a display coupled to a micro processing device and a memory device.
  • the graphical user interface has an electronic representation of a first body image and a second body image and an electronic map representing the position of nodules on the first body image and second body image.
  • a result in image is derived by a binary operation between two input images.
  • US 2015/339820 A1 relates to a method for concurrent navigation of sets of a plurality of biomedical images, the method includes visualizing, side-by-side or in overlay, sets of two biomedical images that include a reference image A and a comparison image B.
  • the present invention provides a method, including receiving two or more surface representations of at least a portion of an organ of a patient and overlaying them.
  • the two or more received surface representations are registered one with the other.
  • One of the surface representations is selected as a base map.
  • a draggable geodesic region is generated for at least one of the two or more surface representations not selected as a base map, wherein the geodesic region is configured to follow varying anatomy as the region is dragged over the base map.
  • the draggable geodesic region is overlaid on the base map to generate a mixed multilayer representation, and the mixed multilayer representation is presented to a user.
  • the two or more surface representations include different types of electroanatomical (EA) maps.
  • the different types of EA maps include color coded EA maps.
  • the different types of EA maps include a bipolar map and a local activation time (LAT) map.
  • LAT local activation time
  • the geodesic region has a circular shape. In other embodiments, the geodesic region is dragged in response to a user input.
  • the method further includes, in response to the user input, selecting another surface representation as a base map, and generating the draggable geodesic region for at least one of the two or more surface representations not selected as a base map.
  • a system including a memory and a processor.
  • the memory is configured to store two or more surface representations of at least a portion of an organ of a patient.
  • the processor is configured to (a) register the two or more received surface representations one with the other, (b) select one of the surface representations as a base map, (c) generate for at least one of the two or more surface representations not selected as a base map, a draggable geodesic region, wherein the geodesic region is configured to follow varying anatomy as the region is dragged over the base map, (d) overlay the draggable geodesic region on the base map to generate a mixed multilayer representation, and (e) present the mixed multilayer representation to a user.
  • Catheter-based electroanatomical (EA) mapping techniques may produce various types of EA maps of an organ, such as a left atrium of a heart.
  • EA maps may be used to interpret the EA maps. For example, to check for cardiac scar tissue, the physician may look at a local activation time (LAT) colored map and also at a bipolar potential colored map. The physician may toggle between the maps, or place them in two windows side-by-side. Either way is time consuming, and for both methods, because there is no registration, it is difficult to compare specific anatomical regions exactly.
  • LAT local activation time
  • the physician may need to visually examine other types of maps, for example, cardiac wall thickness and/or locations of major blood vessels in the region, further complicating the task of the physician.
  • Embodiments of the present invention that are described herein provide real-time and integrative mode methods for overlying one or more regions of surface representations, such as of EA maps or of other types of maps, on another surface representation, that may also be a type of an EA map.
  • a processor registers two or more surface representations one with the other. Then, the processor selects one of the surface representations as a base map, based on user discretion or a prespecified protocol. The processor generates, for at least one of the two or more surface representations not selected as a base map, a draggable geodesic region, wherein the geodesic region is configured to follow varying anatomy as the region is dragged over the base map. The processor overlays the draggable geodesic region on one of the surface representations that serves as a base map. Finally, the processor presents a resulting mixed multilayer representation comprising the at least one draggable geodesic region to a user.
  • the processor is further configured to provide a function, for example, to select another surface representation as a base map from a user interface tool, and to generate the draggable geodesic region for at least one of the two or more surface representations not selected as a base map.
  • a variant of the disclosed method in which the processor opens one or more windows, in one or more outer layers of the multiple layer representation, in order to view one or more inner layers therethrough.
  • An opening of geodesic windows gives equivalent results as overlaying geodesic regions, by (i) reversing the order of maps, and (ii) opening geodesic windows in outer maps to view regions of the inner maps.
  • overlaying geodesic regions, or opening geodesic windows are two means to achieve a similar user experience and similar benefits for the physician.
  • the physician can move the geodesic region by dragging the geodesic region with a user interface tool, such as a computer mouse and/or touch screen.
  • a user interface tool such as a computer mouse and/or touch screen.
  • a processor overlays a circular geodesic region of a bipolar potential map on a LAT map.
  • the physician can, for example, quickly check whether or not a cardiac tissue region is scarred, without the need to switch (i.e., to toggle) between the two EA maps.
  • a LAT map may be overlaid in a geodesic region where the geodesic region has a different LAT range than the main map.
  • the order of the EA maps may be exchanged (i.e., a geodesic region of the LAT map being overlaid on the bipolar potential map), by the physician toggling between two ordering options of the mixed map using, for example, the user interface tool.
  • the physician may reorder layers to select which layer would constitute a base map and which layers have regions overlaid on the base map.
  • multiple geodesic regions may be opened simultaneously and independently placed and moved on the map.
  • the processor is programmed with a particular algorithm that enables the processor to conduct each of the processor-related steps and functions outlined above.
  • the disclosed techniques may assist the physician in the interpretation of two or more types of EA maps, as well as of other types of maps, of the same organ.
  • the disclosed technique may thus expedite and improve the quality of complicated diagnostic tasks, such as those required in diagnostic catheterizations.
  • Fig. 1 is a schematic, pictorial illustration of a system for electroanatomical (EA) mapping, in accordance with an exemplary embodiment of the present invention.
  • Fig. 1 depicts a physician 27 using an EA Pentaray ® catheter 29 to perform an EA mapping of a heart 23 of a patient 25.
  • Catheter 29 comprises, at its distal end, one or more arms 20, which may be mechanically flexible, each of which is coupled with one or more electrodes 22.
  • electrodes 22 acquire and/or inject unipolar and/or bipolar signals from and/or to the tissue of heart 23.
  • a processor 28 receives these signals via an electrical interface 35, and uses information contained in these signals to construct an EA map 31 that processor 28 stores in a memory 33.
  • processor 28 may display EA map 31 on a display 26.
  • EA map 31 comprises a circular geodesic overlay region of a bipolar potential map overlaid on a LAT map, as shown in Fig. 2 and described in detail subsequently.
  • a tracking system is used to track the respective locations of sensing-electrodes 22, such that each of the signals may be associated with the location at which the signal was acquired.
  • ACL Advanced Catheter Location
  • a processor estimates the respective locations of the electrodes based on impedances measured between each of the sensing-electrodes 22, and a plurality of surface-electrodes 24, that are coupled to the skin of patient 25.
  • three surface-electrodes 24 may be coupled to the patient's chest, and another three surface-electrodes may be coupled to the patient's back. (For ease of illustration, only one surface-electrode is shown in Fig. 1 .) Electric currents are passed between electrodes 22 inside heart 23 of the patient, and surface-electrodes 24. Processor 28 calculates an estimated location of all electrodes 22 within the patient's heart based on the ratios between the resulting current amplitudes measured at surface-electrodes 24 (or between the impedances implied by these amplitudes) and the known positions of electrodes 24 on the patient's body. The processor may thus associate any given impedance signal received from electrodes 22 with the location at which the signal was acquired.
  • Fig. 1 The example illustration shown in Fig. 1 is chosen purely for the sake of conceptual clarity. Other tracking methods can be used, such as ones based on measuring voltage signals. Other types of sensing catheters, such as the Lasso ® Catheter (produced by Biosense Webster) may equivalently be employed. Contact sensors may be fitted at the distal end of EA catheter 29. As noted above, other types of electrodes, such as those used for ablation, may be utilized in a similar way, fitted to electrodes 22 for acquiring the needed position data. Thus, an ablation electrode used for collecting position data is regarded, in this case, as a sensing-electrode. In an optional embodiment, processor 28 is further configured to indicate the quality of physical contact between each of the electrodes 22 and an inner surface of the cardiac chamber during measurement.
  • processor 28 is further configured to indicate the quality of physical contact between each of the electrodes 22 and an inner surface of the cardiac chamber during measurement.
  • Processor 28 typically comprises a general-purpose computer with software programmed to carry out the functions described herein.
  • processor 28 runs a dedicated algorithm as disclosed herein, including in Fig. 3 , that enables processor 28 to perform the disclosed steps, as further described below.
  • the software may be downloaded to the computer in electronic form, over a network, for example, or it may, alternatively or additionally, be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory.
  • Fig. 2 is a schematic, pictorial volume rendering of a mixed electroanatomical (EA) map of a left atrium 40, in accordance with an exemplary embodiment of the present invention.
  • Fig. 2 shows a draggable circular geodesic region 60 of a bipolar potential map overlaid on a LAT map 50.
  • Geodesic region 60 shows color coded bipolar ECG signal amplitude
  • LAT map 50 shows color-coded activation times (both shown herein in gray scale).
  • the physician may move circular geodesic overlay region 60, for example, by dragging the inside of the circle, and also change the radius of circular region 60. Using the geodesic overlay, the physician can, for example, quickly check whether or not a cardiac tissue region is scarred without switching (i.e., toggling) between the two EA maps.
  • Fig. 2 shows a circular geodesic overlay region
  • the overlaid region may have another shape, for example, one that provides an isometric view that varies with location over the organ.
  • Fig. 2 shows a mixed dual-layer EA map
  • the disclosed technique may overlay regions from more maps, so as to create a multilayer map that comprises two or more overlaid geodesic regions, of which at least one is not an EP map, such overlay region indicating, for example, cardiac wall thickness.
  • processor 28 may adjust one or more maps to best fit the current main map. In doing so, information from other maps will be properly displayed within the geodesic region of interest on the main map.
  • Fig. 3 is a flow chart that schematically illustrates a method for generating the mixed electroanatomical (EA) map of Fig. 2 , in accordance with an exemplary embodiment of the present invention.
  • the algorithm carries out a process that begins with processor 28 receiving LAT and bipolar potential EA maps of left atrium 40, at a map-receiving step 70.
  • the processor uploads the maps from memory 33.
  • processor 28 registers the bipolar map with the LAT map, at a map registration step 72.
  • processor 28 selects LAT map 50 as a base map, at a base map selection step 74.
  • Processor 28 generates a draggable geodesic region 60 of the bipolar potential map, and overlays region 60 on LAT map 50, at a region overlaying step 76.
  • processor 28 presents the resulting mixed EA map 102 on a display to the physician, at a mixed map presenting step 78.

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Claims (14)

  1. Verfahren, umfassend:
    Empfangen von zwei oder mehr Oberflächendarstellungen von mindestens einem Anteil eines Organs eines Patienten;
    Registrieren der zwei oder mehr empfangenen Oberflächendarstellungen miteinander;
    Auswählen einer der Oberflächendarstellungen als eine Basiskarte;
    Generieren, für mindestens eine der zwei oder mehr Oberflächendarstellungen, die nicht als eine Basiskarte ausgewählt sind, einer verschiebbaren geodätischen Region der mindestens einen oder mehreren Oberflächendarstellungen, die nicht als eine Basiskarte ausgewählt sind, wobei die geodätische Region konfiguriert ist, um variierender Anatomie zu folgen, wenn die Region über die Basiskarte verschoben wird;
    Überlagern der verschiebbaren geodätischen Region auf der Basiskarte, um eine gemischte mehrschichtige Darstellung zu generieren; und
    Präsentieren der gemischten mehrschichtigen Darstellung einem Benutzer.
  2. Verfahren nach Anspruch 1, wobei die zwei oder mehr Oberflächendarstellungen unterschiedliche Arten von elektroanatomischen Karten (EA-Karte) umfassen.
  3. Verfahren nach Anspruch 2, wobei die unterschiedlichen Arten von EA-Karten farbcodierte EA-Karten umfassen.
  4. Verfahren nach Anspruch 2, wobei die unterschiedlichen Arten von EA-Karten eine bipolare Karte und eine Karte der lokalen Aktivierungszeit (LAT-Karte) umfassen.
  5. Verfahren nach Anspruch 1, wobei die geodätische Region eine runde Form aufweist.
  6. Verfahren nach Anspruch 1, wobei die geodätische Region als Reaktion auf eine Benutzereingabe verschoben wird.
  7. Verfahren nach Anspruch 6, und umfassend, als Reaktion auf die Benutzereingabe, das Auswählen einer anderen Oberflächendarstellung als eine Basiskarte und das Generieren der verschiebbaren geodätischen Region für mindestens eine der zwei oder mehr Oberflächendarstellungen, die nicht als eine Basiskarte ausgewählt sind.
  8. System, umfassend:
    einen Speicher, der konfiguriert ist, um zwei oder mehr Oberflächendarstellungen von mindestens einem Anteil eines Organs eines Patienten zu speichern;
    eine Anzeige (26); und
    einen Prozessor, der konfiguriert ist zum:
    Registrieren der zwei oder mehr empfangenen Oberflächendarstellungen miteinander;
    Auswählen einer der Oberflächendarstellungen als eine Basiskarte;
    Generieren, für mindestens eine der zwei oder mehr Oberflächendarstellungen, die nicht als eine Basiskarte ausgewählt sind, einer verschiebbaren geodätischen Region der mindestens einen oder mehreren Oberflächendarstellungen, die nicht als eine Basiskarte ausgewählt sind, wobei die geodätische Region konfiguriert ist, um variierender Anatomie zu folgen, wenn die Region über die Basiskarte verschoben wird;
    Überlagern der verschiebbaren geodätischen Region auf der Basiskarte, um eine gemischte mehrschichtige Darstellung zu generieren; Präsentieren der gemischten mehrschichtigen Darstellung einem Benutzer auf der Anzeige (26).
  9. System nach Anspruch 8, wobei die zwei oder mehr Oberflächendarstellungen unterschiedliche Arten von elektroanatomischen Karten (EA-Karte) umfassen.
  10. System nach Anspruch 9, wobei die unterschiedlichen Arten von EA-Karten farbcodierte EA-Karten umfassen.
  11. System nach Anspruch 9, wobei die unterschiedlichen Arten von EA-Karten eine bipolare Karte und eine Karte der lokalen Aktivierungszeit (LAT-Karte) umfassen.
  12. System nach Anspruch 8, wobei die geodätische Region eine runde Form aufweist.
  13. System nach Anspruch 8, wobei die geodätische Region als Reaktion auf eine Benutzereingabe verschoben wird.
  14. System nach Anspruch 13, wobei der Prozessor ferner konfiguriert ist, um als Reaktion auf die Benutzereingabe eine andere Oberflächendarstellung als eine Basiskarte auszuwählen und die verschiebbare geodätische Region für mindestens eine der zwei oder mehr Oberflächendarstellungen zu generieren, die nicht als eine Basiskarte ausgewählt sind.
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